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Abstract

A small but significant spate of health and nutrition studies was completed in Northern Newfoundland and Southern Labrador in the first third of the 20th century. Published in peer-reviewed journals, such as the Journal of the American Medical Association and the Irish Journal of Medical Sciences, the research was sponsored by the International Grenfell Association (IGA), led by zealous Christian missionary and physician Wilfred Grenfell. The paper contributes to Canadian food studies by providing insights into the challenging social and economic conditions faced by the people of the region and the persistence of European food ways, despite the vastly different geophysical setting. It demonstrates that the studies had widespread impacts as they advanced the understanding of deficiency diseases. Yet the interventions had limited local benefits and were not generally successful over time. In keeping with contemporary approaches, the IGA’s nutrition research restricted community development by maintaining and institutionalizing patron-client relationships. This methodology likely led to missed opportunities in terms of community health and development.

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Nutrition Studies in Northern Newfoundland

Under the auspices of the International Grenfell Association (IGA), health care providers carried out a spate of nutrition studies and interventions on Newfoundland’s Great Northern Peninsula and, in some cases, Southern Labrador, in the first third of the 20th-century. These nutrition studies made significant contributions to the emerging field of nutrition research, which benefitted populations worldwide. In its operations, the IGA operated in the top-down missionary-style of the era, eschewing local and Indigenous knowledge and experiences and the community development principles as we would expect to see today. For instance, the Inuit practice of using of birds’ liver consumption as a remedy for night blindness, was not encouraged generally. This is not necessarily surprising but, as this paper demonstrates, IGA staff also paid little heed to the local geophysical environment with the result that they inadvertently minimized their potential for good in the region and thus indirectly caused harm. An example of this is the introduction of Carnation Milk, which came to replace breastfeeding.

The IGA was founded in 1914 by Englishman Dr. Wilfred Grenfell [1], who, from 1891, had been superintendent of the Royal National Mission to Deep Sea Fishermen (RNMDSF). [2] In that role, Grenfell established a mission station at Battle Harbour, Labrador and a hospital at St. Anthony, Newfoundland, finally severing his ties with the RNMDSF in 1913 to strike out on his own. [3] Similar to the RNMDSF’s, the IGA’s role was “to provide health care, education, religious services, and rehabilitation and other social services to the fisherman and coastal communities of northern Newfoundland and coastal Labrador.” [4] Like other medical services of the time, both the RNMDSF and the IGA relied on philanthropy motivated by Christian religious conviction. In 1908, the Rockefeller Institute’s Sanitary Commission, for instance, initiated a campaign against hookworm, which caused anemia, in the Southern United States, paying particular attention to the health of Baptists. [5] Rockefeller’s vast wealth ensured great success in providing health services but Grenfell was also extremely successful. By 1914, his Newfoundland and Labrador operations consisted of: four hospitals; six remote nursing stations; six year-round doctors with 14 working seasonally; 18 nurses; 150 volunteers; and an annual budget of $66,000 [6] or $1,500,000 in today’s dollars, according to the Bank of Canada. This was in addition to industrial workshops, residential schools, cooperatives, and a dry dock, as well as a fox farm and a reindeer importation project, both of which failed. [7] With his American lecture tours, which irritated the government by portraying Newfoundland as desperately poor, and his books, ghostwritten by his heiress wife, Grenfell raised $20,000 ($500,000 today according to the Bank of Canada) in a single month. [8]

The IGA was founded as the world entered a new era of medicine; a partially effective tuberculosis vaccine was developed in 1921, followed by a diphtheria vaccine two years later and antibiotics would change medicine forever after 1940. [9] In combination with environmental disease control efforts, these developments added more than 20 years to life expectancy between 1920 and 1940. [10] In 1906, Frederick Dowland Hopkins explained that certain diseases were caused by “unsuspected dietetic factors,”specifically insufficient amounts of one or more dietary elements. [11] By 1912, these factors had been identified as vitamins or “accessory food factors” [12] and, because of the nutrition issues in Newfoundland, they caught the attention of IGA researchers. The researchers published their work in the following journals: the Canadian Medical Association Journal, [13] the Journal of the American Medical Association, the Boston Medical and Surgical Journal, the American Journal of Public Health, the Irish Journal of Medical Sciences, the Journal of Hygiene, the Journal of the American Dietetic Association. Despite their geographical (and methodological) limitations the studies also influenced food practices [14] throughout Newfoundland and became the basis for two nutrition interventions. Yet because of its top-down approach, the IGA’s involvement in local food history represents lost potential for community health and development.

Northern Newfoundland and Labrador

Northern Newfoundland was settled by people of European (mainly British Isles) descent in
the mid-1800s, and a little earlier in the case of some communities. [15] Southern Labrador is the long-time home of people now known as Southern
Inuit; from the early to mid-1800s, British men trickled in and married Inuit
women. [16] The region is geographically isolated [17] and is characterized by boreal forest and sub-Arctic tundra. It
has a harsh climate; its long winters have high snowfalls and its harbours are ice-bound
for months. [18] Settlement was discouraged by the British
because the French had treaty rights giving them exclusive access to local fishing. [19] Because of its history and geography, the area has always been
sparsely populated. [20] Historical demographic data is
challenging; many of the communities in which the IGA was active do not appear in the
Newfoundland Census until 1921, according to my search; others have changed their names or
been resettled or abandoned. But even today, at just over 10,000, the population is small
and spread out over 8750 square kilometers along a 181km stretch of road, [21] which I estimate to be the IGA’s area in Newfoundland; this
gives a population density of .87 people per square kilometre. (Newfoundland itself is not
densely populated with only 1.4 people per square mile compared to 3.7 for Canada. [22])

The Northern Newfoundland Diet

In Northern Newfoundland in this period, thick sea ice meant food could be imported only in summer and fall with such foodstuffs long gone by the time summer arrived. In summer, people had to rely exclusively on local foods. The summer fishery, around which the Newfoundland economy revolved, was extremely labour-intensive, leaving little time for farming. [23] The rural economy was governed by the truck (or barter) system through which fishermen exchanged fish for imported groceries; this system encouraged people to focus on the fishery as fish was effectively currency. [24] The diet was characterized by summertime fish consumption and reliance on imported foods, such as molasses, tea and flour in winter. [25] Since European settlement, there has been limited agriculture in Northern Newfoundland; besides the labour-intensiveness of the fishery, soil conditions were poor and the weather was harsh. [26]

Yet, following their European ancestors, local people were attached to farming. Milk cows, sometimes shared among families, were not well-nourished. [27] Consequently, they produced low quantities of milk. [28] Root crops, especially potatoes, turnips, and cabbage were grown, but “The fresh vegetables seldom last(ed) longer than December, and in many cases only enough are raised for a few meals.” [29] People did not consume fresh meat in large quantities and they ate eggs only “now and again.” [30] The staples were white flour bread and salt meat in the tradition of British sailors. Raspberries, partridge berries, bakeapples (cloudberries) and blueberries were abundant [31] but “hard to gather.” [32]

Researchers agreed that the monotonous diet was deficient, particularly in winter: “...
quality rather than quantity of the food supply may be at fault.” [33] But there was also the quality issue of low vitamin intake. [34] In the words of Wallace Aykroyd, an Irish nutritionist, “On
such a diet deficiency diseases naturally develop.” [35] Food
shortages and subsequent insufficient food intake seemed to be normalized in the local
culture: “There are many who are well satisfied if they have enough flour, tea and
molasses to see them through the winter,” wrote surgeon John Little, [36] formerly of Massachusetts General Hospital. [37]

Deficiency Diseases Identified

IGA researchers identified a number of diseases in the region. V.S. Appleton, also a physician, found that potentially fatal beriberi, which inflamed the nerves and caused heart failure, was prevalent in Newfoundland but rare in Labrador. [38] It was most common among men while women seemed to be relatively immune and children were rarely afflicted. [39] Dr. Little saw the links between beriberi and nutritional deficits, especially white flour. [40] American dieticians Margery Vaughn and Helen Mitchell recorded a beriberi rate of 19% and 21% respectively in Pines Cove and Green Island Cove. [41] The lowest rate of beriberi was 3.3% in Savage Cove; this community also had relatively low rates of other deficiency diseases. [42] Night blindness or nyctalopia, an inability to adjust to dim light, was the “commonest” of the deficiency diseases [43] and appeared mainly among men who were doing active outdoor work. [44] By Aykroyd’s “rough reckoning,” no less than one-quarter of the population of Northern Newfoundland and Southern Labrador suffered from night blindness. [45] The traditional Inuit remedy was the consumption of Vitamin A-rich raw bird livers, a cure also practiced in many other cultures, including in ancient Egypt [46] and ancient Greece but it appears from the IGA nutrition studies that Northern Newfoundland settlers did not adopt the cure.

Rickets, Vitamin D-deficient premature bone calcification leading to deformities and disability, was recorded but it was uncommon and severe rickets was very uncommon; symptoms were usually mild in degree. [47] However, some communities recorded relatively high incidences; 12.9% of the people of Pines Cove, Newfoundland suffered rickets in 1930. [48] Rickets was rare among the Inuit, which surprised some of the researchers in view of the northern climate with its relative lack of sunlight. Aykroyd attributed the low rate of rickets to the Inuit practice of regularly consuming fresh livers as a tonic; here was a missed opportunity for the settler population to preserve their bone health by using Indigenous practices, but their European food culture apparently just too entrenched . [49] Aykroyd reported that women, most of whom would have been Indigenous, in Labrador were in the practice of giving their children Vitamin D-rich cod liver oil, as a tonic [50] but it seemed that this was not the habit in Newfoundland [51].

Tuberculosis was noted; [52] in 1930, 6.4% of the Pines Cove population had this disease with Shoal Cove, Eddies Cove and Upper Harbour all having rates of over 5% [53] although other communities had no incidences. [54] In 1929, Mitchell observed a lack of pep and ambition [55], an observation that would be repeated again in 1945. [56] Here, the researchers, most of whom had only brief stays in Newfoundland, misunderstood the reticence and introversion of output culture and misinterpreted it with a moral slant, an attitude that featured strongly in the nutrition interventions sponsored by the IGA.

Drawing from the Researchers’ Findings

The studies showthat the settler population of Northern Newfoundland attempted to reproduce
the food patterns of their European, mainly British Isles, ancestors which proved
challenging in the geophysical environment in which they now found themselves. The climate
was much more challenging than that of England’s West Country, say. Northern
Newfoundland’s soil conditions did allow for small-scale farming [57] but were not as favourable as those in Britain. Prior to 1940, farming
throughout the western world was labour-intensive. [58] In
the case of Newfoundland, this was undoubtedly the case and it meant significant demands
on a population already involved in the fishery, which was equally
labour-intensive. [59] Although Southern Inuit lived nearby
in Labrador and Mi’kmaq inhabited much of the island of Newfoundland, the incorporation of
Indigenous food practices by settlers was limited; hunting activity in winter, for
instance, was minimal and settlers did not consume abundant Alexander, also known as horse
parsley. Alterations to European food practices and increased use of Indigenous practices
, such as more liver consumption, might have mitigated against nutrition-related health
problems in Northern Newfoundland.

Nutrition Interventions

There were two important interventions in Northern Newfoundland during this period, - led by Vaughn and Mitchell. Initiated in 1929, these interventions were centred at Flowers Cove but covered an area of 70 miles of “rough coast” and involved 1500 people. [60] The dietitians indicated that the quality of the diet was poor, especially for families relying on what was then called government “dole” (i.e. poor relief from the government) and consisted mainly of white flour. [61]

The first intervention was a dietary survey of Northern Newfoundland and Southern Labrador followed by the distribution of milk, oranges, whole cereals and bran; it also had an educational component consisting of “simple posters, in the [plain English] language of the people.” [62] The second intervention was longer at one year’s duration and multi-pronged, consisting of the issuing of garden seeds, the establishment of garden clubs, garden contests, a Health Week with cooking demonstrations and prizes, a campaign to promote the use of cod liver oil, and the distribution of evaporated milk with products donated by the Evaporated Milk Association, and a school lunch program that had the hoped-for outcome of weight gain in children. [63] The interventions were well-received with some people walking 30 miles (or 48.2 kilometres) in the rain to take part in events. [64]

Analyzing the Interventions

The IGA developed interventions based on its religious mission and eschewed the principles
of community development recognized today [65]; its leaders
paid little attention to setting and local skill sets, and did not facilitate broad
participation in program development or decision-making. The nutrition researchers and
their sponsors — American universities and the IGA — had full confidence in their own
authority and little faith in the abilities and knowledge of the local settler population
or the natural resources that surrounded them. Grenfell’s approach was colonial,
entrenching dependency through the patron-client relationships he established with both
settlers and Indigenous people. More specifically, the dietitians did not take a
comprehensive or even comparative approach that would have revealed useful information and
building blocks for interventions. For instance, there were few deficiency diseases among
the Inuit, with kallak – pustule-like skin
lesions, intense itching, and secondary infection – being a rare exception. [66] The appearance of kallak was attributed to the increasing Inuit dependence on cod as Little
noted “... if they have plenty of seal flesh to eat, they don’t have kallak.” [67] Another contemporary study concluded that dental health was
poor in both Northern Newfoundland and Labrador, except among those Inuit who continued to
eat largely as their ancestors did. [68]

Despite the obvious usefulness of Indigenous food practices, the emphasis of the
interventions was on agriculture and it was exclusive: as Little argued, “... the creation
of a desire for a change in living conditions must be (the dietician’s) first objective.
More agriculture seemed to be a feasible means of bettering conditions.” [69] There was no rationale provided for this decision and it
reveals a lack of awareness of the real constraints on agriculture. The people at whom the
interventions were targeted were already relying on European food practices, with worrying
outcomes; in spite of this, the dieticians urged them to intensify their efforts in this
direction, rather than expanding their knowledge of food acquisition and associated
practices.Vaughn and Mitchell naïvely wrote, “More and more of these people are now
beginning to realize that their future living must come from the soil rather than the
sea.” [70] On the other hand, the dieticians were able to
bring about increased consumption of whole wheat flour and to encourage berry-picking,
which was an appropriate activity for the geophysical environment and long been practiced
by neighbouring Indigenous populations. Despite local geophysical conditions, the
prescriptive approach of the researchers emphasized correctives used in agricultural areas
of North America; the emphasis on agriculture is an example of this. With few exceptions,
local resources, traditions, and ingenuity were not encouraged or even considered.

The researchers’ understanding of the relationships between the challenging socio-economic conditions, diet and disease were uneven and generally not well-developed. When the researchers correlated poverty, especially food insecurity, with disease, this correlation was not a focus of their work; this has implications for the kinds of interventions they advocated. [71] Often the researchers’ recommendations were focused rather than holistic, consisting only of a particular change in diet, such as Little’s advocacy of the consumption of whole wheat flour to prevent beriberi. [72] The researchers stopped short of identifying policy-based or structural solutions that might address the socio-economic conditions that underlay many of the health problems. They did not emphasize poverty alleviation to advance community health and saw little role for government which had the ability to develop and deliver food policy. Even the potential of local collective action was ignored, although families shared cows. Their work reflected the religious orientation of the IGA, conventional wisdom, and values imported from the United States and Tory Britain; “The people are learning more and more that good nutrition and future health are dependent upon their own efforts to better their living conditions and that the government dole is an uncertain and unsatisfactory solution to their problems.” [73] Thus, government and public infrastructure were slow to develop in Newfoundland, leaving a policy void that was filled by the IGA. [74]

The IGA dieticians did not see government as a resource and characterized government assistance as uncertain; yet they ignored the uncertainty of food resources. Local people had some unwise practices but some practice did indeed work. eIn the interventions, the people received knowledge and were not given the opportunity to contribute to it. This is likely one reason the interventions were not generally successful in the long term and might even have contributed to led to long-term negative impacts. For instance, recent research demonstrates that the widespread distribution of evaporated milk resulted in the over-use of this food product in infant feeding in Newfoundlandwhich corresponded to low breast-feeding rates and short breast-feeding terms. [75] Generations of Newfoundland children were “Carnation babies” with these babies needing iron supplements to avoid or limit anemia. [76] “Carnation babies” had lower selenium intakes, which is associated with male infertility and with a type of osteoarthritis,and were believed to have inadequate thiamin intake, which is associated with weight loss, muscle weakness, and cardiovascular problems. [77]

Conclusion: Filling the Gap

The Newfoundland government had no reason not to support small-scale agriculture – as well as the local fishery – but there was a pattern of official neglect. [78] At best, government’s approach was piecemeal rather than systematic or comprehensive; one of the actions taken was to distribute whole wheat flour to welfare recipients in 1934. [79] In 1969, the provincial government achieved its exporting goal by building a coastal road on the Great Northern Peninsula -- through most of the arable land. [80]

In the early twentieth century, the IGA filled the gap left by government. Its studies and interventions made a contribution by increasing out understanding of the lives of the people of Northern Newfoundland and Labrador prior to the Great Depression and the war and industrialization that followed it. The mistake is to generalize too much from the studies since socio-economic and even climatic conditions varied considerably throughout this vast territory. On a wider scale the research advanced human understanding of nutrition, especially vitamins.

The IGA restricted community development, however, by substituting the truck system for its
own barter system, creating new hierarchical relationships. [81] The organization, then the most significant and powerful institution in
Northern Newfoundland and in Southern Labrador, was focused on maintaining its
patron-client relationships, religious salvation being the chief end, in spite of the
professional intentions of some of the medical staff and researchers. The IGA was built on
Grenfell’s robust Protestant Christianity, which firmly shaped and guided its work, with
the result being lost potential for community health and development. As former IGA
physician Gordon Thomas stated, the IGA conducted its business “in an extremely
paternalistic although well-motivated manner, by outside persons with no local
involvement.” [82] Thus, this paper describes missionary
interventions in rural and remote community health, fleshing out Thomas’ point. The paper
also indicates missed opportunities that were the result of the approaches taken by the
IGA.

To the credit of the IGA, community-based research, with its incorporation of local knowledge and its involvement of community memberships as research partners, is a relatively new phenomenon. Only visionaries would have considered it at the time. Yet, the IGA food history demonstrates that research without these principles is more likely to fail and may even cause harm. We can only wonder what innovations a genuine partnership would have resulted in if, working with health experts, the people had been able to define their problems in their own terms and identify priorities and solutions. With its religious mandate and concern for what it saw as the moral status of the people, the IGA represented a fairly extreme version of top-down research. The missed opportunity aspect of this approach is not generally recognized even now yet it continues to affect the people of the region and elsewhere in Newfoundland and Labrador today.

Over the long-term the IGA’s interventions were not generally successful. A 1985 dietary survey of St. Anthony found that cereal fibre and whole wheat flour consumption was low, explaining: “Most women bake their own bread which is always white.” [83] Fruit and vegetable consumption was low, with root crops like potatoes and turnips comprising the majority of vegetables in local people’s diets. The fishery continued to be the main economic activity until the devastation of the groundfish stocks and the subsequent moratoria in 1992. Like most missionaries, Grenfell saw himself as a teacher but the lessons his organization imparted were not necessarily those he intended, at least partly because Indigenous and locally-based solutions were ignored. At the same time, the IGA’s contribution to nutrition research, then in its infancy, has to be recognized. The people of Northern Newfoundland might have reaped only limited benefits from this research but the residents, small in number and isolated, played a role in advancing our understanding of deficiency diseases and their causes and cures.

Appendices

Footnotes

[1]Paul Butler’s 2014 novel The Good Doctor
(St. John’s: Pennywell, 2014) is one of few studies that treats Grenfell as a complex and
deeply flawed character rather than as a singularly heroic figure.

[14]The three interconnected categories of food practices are: food production and
processing, food distribution and retail, and food consumption. (Gert Spaargaren, Peter
Oosterveer, and Anne Loeber, eds. Food practices in
transition: changing food consumption, retail and production in the age of reflexive
modernity. Routledge, 2013.)

[15]Craig T. Palmer and Peter R. Sinclair. “Expecting to Leave: Attitudes to Migration
Among High School Students on the Great Northern Peninsula of Newfoundland,” Newfoundland Studies 16, No. 1 (2000): 30-46.

[16]Maura Hanrahan. "Industrialization and the politicization of health in Labrador
Métis society." Canadian Journal of Native Studies
2 (2000): 231-250.

[46]George Wolf. “A historical note on the mode of administration of vitamin A for the
cure of night blindness6”. The American Journal of Clinical
Nutrition 31(February, 1978): 280-292; Aykroyd, “Vitamin A
Deficiency.”

[74]James Overton. “Brown Flour and Beriberi: The Politics of Dietary and Health Reform
in Newfoundland in the First Half of the Twentieth Century,” Newfoundland and Labrador
Studies 14, No. 1 (1998): 1-27.

Biographical note

Maura Hanrahan is an associate professor in the Department of Native American Studies, University of Lethbridge, Alberta. She has published in Food, Society and Culture, Arctic Anthropology, the Water Quality Research Journal of Canada, the Canadian Journal of Native Studies and other journals and is the author of several books.